Statement of the Minister of Health and Social Development of Venezuela, Gilberto Rodríguez Ochoa

I would first like to congratulate my colleagues, the Ministers of Health of Bolivia, Chile, Colombia, Ecuador and Peru for the work they have been doing to build up this network and the Executive Secretariat of the Hipólito Unanue Convention for this magnificent undertaking.

The emergency created in Venezuela by the torrential rains during the last month of 1999 is one of the greatest disasters ever to occur in our country, and has had catastrophic consequences for the people directly affected and for Venezuela’s national development process: there are roughly 400,000 victims, 200,000 have been evacuated, and some 115,000 are homeless. The exact death toll has not yet been computed because of the large number of persons who are buried under the heavy layer of mud, among the debris, in the ocean or under water. About 81,000 homes and buildings have been affected, of which 26,000 have been completely destroyed or are beyond repair. Whole towns and villages have disappeared. A large part of our road system has been closed down; bridges have collapsed and dams have burst. Large areas of highly productive farmlands have been flooded. The water and electricity supply have been interrupted by the collapse of the systems. Health centers and schools have been destroyed. Trade and industry have been affected by the closure of companies and close to 200,000 jobs have been lost. The environmental impact on the marine ecosystem and forest parks has been sizable.

The territory that has been affected is located in the central-northern coastal area of the country, where the exceptionally heavy rainfall caused rivers and streams to burst their banks, widespread flooding bringing the water level to 2 or 3 meters in some zones, and landslides that rushed down steep slopes as huge avalanches of water and mud, trees and large rocks, sweeping away everything in their path. The states that suffered this onslaught were Vargas, the Federal District, Miranda, Falcón, Yaracuy, Zulia, Guárico, Nueva Esparta, Sucre, Táchira and the Galipán Sector of the Avila National Park. Those hardest hit by the landslides are Vargas state and the Federal District, where a large number of human settlements were located in high risk zones, and the states of Miranda, Falcón, Yaracuy and Zulia, which lost large areas of farmland and part of their rural and urban road system.

Despite the size and seriousness of the disaster, the response was immediate and massive from all social sectors and the international community. A huge search and rescue operation was launched with the participation of the military, civilians, private business, the national financial sector and international aid. Some 338 refuge shelters for the homeless were outfitted in 22 of the country’s states, in addition to the military garrisons where people were accommodated. A large number of children with missing or dead parents have been given shelter and protection. An epidemiological control and monitoring center was activated for the emergency. Working committees were set up by sectors and volunteer groups and brigades have undertaken to provide care, preventive assistance and help with psycho-social traumas in communities and shelters for the homeless until the temporary disruption of the country’s normal social and economic activities and organization has been remedied.

Today the Ministry is coordinating the Second Phase of the Emergency Plan, now that the initial phase of rescue and assistance to the victims in communities and shelters for the homeless has been completed. This phase will be directed toward carrying out a process of intermediate rehabilitation or establishing the necessary conditions for embarking on the comprehensive reconstruction of the disaster areas. The National Emergency Center (CONACEM) was accordingly brought into operation, with its 13 subcommittees working in the areas of health, social organization and care for the towns affected, water, electricity, the road system, housing, communication, logistics and international assistance. CONACEM’s aim is to coordinate all of the necessary actions to determine the extent of the damages, plan the activities and resources needed to reestablish the basic operation of the services and road system, relocate the families and temporarily cover their vital needs like food, clothing, health, education and housing, control areas of elements of health and environmental risk, and take special measure to prevent them, and produce continuing information for the decision-makers and the media.

The disaster has brought about significant changes in the preexisting morbidity, a negative ecological impact, the relocation and concentration of the victims in different parts of the country, the disarray of public services and the interruption of basic services, creating water shortages and the risk of infectious diseases resulting from polluted water and contaminated food, the disposal of garbage, other solid waste, and excreta, and harmful fauna like dogs, flies, rodents, snakes and scorpions, mosquitoes and the vectors of dengue fever and malaria, together with problems of overcrowding, behavior disorders and ensuring the safety of refugees.

According to the Reports of Diseases in the shelters for the homeless and refuge centers prepared by the Ministry of Health and Social Development’s Epidemiological Monitoring System, the situation was as follows:

Following the disaster, the cases of diseases handled rose sharply from 534 to 18,016 (weeks 50 to 51) and in week 52 the number dropped considerably to 9,883 cases, reaching 1,607 in week 1 of 2000. During the weeks with the largest numbers of cases handled, the first cause of morbidity was wounds, injuries and broken bones; the second, respiratory diseases like pneumonia, bronchial asthma, and pharyngitis; the third, diarrheal diseases in all age groups caused by the food eaten; and fourth, viral diseases accompanied by fever and coughing, together with high blood pressure, diabetic complications, and behavior disorders. Also during this phase, high rates of skin lesions were reported, among them, ringworm, scabies and pediculosis.

During the first phase of the impact, the medicinal products on hand and those available in the commercial establishments were brought to bear on the demands for health care. In the post-impact phase, national and international donations made it possible to supply shelters for the homeless and refugee centers for the care of the victims in communities, refuge centers and the states where the victims of the disaster were taken in.

Epidemic-wise, the Monitoring System for Compulsory Notification Diseases has the following to report: with Malaria, we are in the safe category; the cases of Dengue or breakbone fever have increased and of these between 14 and 22% are cases of hemorrhagic dengue, characterizing the situation as an epidemic as of week 51; Cholera continues to be present in the country, with 395 cases reported over the year, mainly in the eastern states, particularly Sucre; there have been no cases of Human Rabies or Venezuelan Equine Encephalitis; and cases of Diarrheal diseases in all age groups and of Acute Respiratory Diseases have increased.

• Serious environmental sanitation problems exist in several of the devastated areas caused by the presence of sewage flowing through streets and avenues, together with the accumulation of solid waste in inappropriate areas.

• The network of services has been totally or partially destroyed in the areas hardest hit by the disaster.

• The water supply system is inadequate or totally lacking and we are now searching for alternate sources of water for consumption and its increased distribution by means of tank trucks.

• The rodent and flying insect (green flies, white-foot mosquitoes) population has grown.

• An epidemiological warning is in effect due to the leakage of toxic substances.

• Equipment, supplies and medicinal products are in short supply in certain critical areas like water treatment and the control of the vectors of zoonitic, chronic and some epidemic diseases.

• The standard of living and quality of life of the people have deteriorated dramatically and there is difficulty in responding rapidly to their demands.

The health sector’s most urgent needs for international assistance are in the areas of:

• Planning of Health Networks and Rebuilding of the Sanitation Infrastructure.

• Environmental Sanitation for the monitoring and treatment of drinking water and sewage, sold waste and zoonoses.

• Risk Analysis for Disaster Situations.

• Education and training of Human Medical and Non-Medical Resources for Disaster Situations.

• Food Supply.

• Supplies for Health Brigades.

• Applicable technologies for water supply in small communities.

A Health Plan for the Emergency with the following objectives was designed to resolve the health problems of the victims in the short, medium and long terms:

1. To guarantee the health care of the people in the disaster and refuge areas.

2. To prevent the outbreak of epidemics in the disaster and refuge areas and to keep preexisting diseases among the victims and/or homeless population under surveillance.

3. To publicize and promote health education actions aimed at giving the community a role to play in the monitoring and maintenance of appropriate health conditions.

4. To identify the needs in order to prepare and channel the application for national and international assistance, as well as to set up mechanisms to guarantee the effective management of those resources.

The actions that are being taken in accordance with those objectives are:

• Contingency operations: to guarantee the immediate care of the injured and the homeless;

• Epidemiological risk control: by instituting a monitoring system for disaster situations.

• Rehabilitation of the health services network: by identifying and quantifying damages to its physical plant, equipment and human resources;

• Restoration of the supply system for provisions, medicinal products and surgical medical material;

• Heath promotion, education and communication aimed at contributing to self-care and the prevention and reduction of environmental and epidemiological risks;

• Orientation and institution of mechanisms to channel national and international aid toward priority health areas.

A Health Subcommittee was formed as a means of bettering communication and coordination between high-level government officials and the private sector and in order to coordinate the execution, follow-up and evaluation of the plan, as well as to allocate and distribute the resources necessary for its execution. This Subcommittee is comprised of the following institutions: Ministry of Health and Social Development as the group coordinator; Military Health of the Ministry of Defense; the Social Insurance Institute of the Education Ministry (IPASME); the Venezuelan Social Security Institute; SU-SALID of the Federal District and the Private Sector.

The advances that have been made under this plan are:

• Provision of health care to a total of 30,000 persons in homeless shelters and refuge centers and fulfillment of the immunization programs.

• Implementation of special epidemiological monitoring mechanisms in services, refuge centers and affected communities to identify and evaluate risk factors and sectorization of the country into 4 or 5 regions, each with a regional command representing the Health Subcommittee that helps the regions to fight against outbreaks of epidemics. The monitoring and control of environmental risks is performed with regard to: excreta, water, food, solid waste, vectors, and reservoirs.

• Organization of Health and Social Development Brigades to work jointly with the community on environmental sanitation, promotion and prevention activities in Vargas and Miranda states by fostering the establishment of an information network that will make it possible to get a good idea of the people’s health situation.

• Channeling and processing of offers of international assistance from countries and international organizations in coordination with the Foreign Ministry. These have consisted of medicinal products and inputs, medical equipment, food and other humanitarian assistance supplies, as well as the dispatch of medical personnel and experts. We have enjoyed the long-term assistance of teams from Peru, Mexico and the Dominican Republic, as well as the evaluation of experts from Chile and Colombia. At present there are 454 Cuban doctors (epidemiologists, hygienists and graduated nurses) in the country.